Healthy Choices Catch On: Data-informed Evolution of a Social Marketing Campaign.

OBJECTIVE: Describe how a multiyear, mixed-methods evaluation informed the evolution of a healthy eating and physical activity social marketing campaign. DESIGN: Focus groups, A/B survey to test messages and images, telephone interviews (2019) with local programmers, and an annual outcome survey. SETTING: Statewide through multiple channels: billboards, transit signs, social media, website, and program resources like banners and posters. PARTICIPANTS: Supplemental Nutrition Assistance Program-Education eligible adults, focusing on mothers and caregivers. INTERVENTION(S): Healthy Choices Catch On originally launched in 2006 and has since evolved. MAIN OUTCOME MEASURE(S): Fruit and vegetable consumption, physical activity, and campaign recall. ANALYSIS: Univariate descriptive statistics and multivariate, weighted linear regression modeling. Interview transcriptions were analyzed for common themes. RESULTS: The multiyear evaluation demonstrated a steady increase in campaign exposure from 2013 to 2017, followed by a decline when new messages and images were introduced in 2018 and 2020. People with greater exposure to messages were more likely to eat more fruits and vegetables and be physically active. CONCLUSIONS AND IMPLICATIONS: Using a combination of evaluation methods can help inform campaign design and evolution while also demonstrating reach and impact.

Policy, Systems, and Environmental Change Strategies in the Supplemental Nutrition Assistance Program-Education (SNAP-Ed).

OBJECTIVE: To categorize and quantify how states planned to use policy, systems, and environmental (PSE) change strategies in the Supplemental Nutrition Assistance Program-Education (SNAP-Ed). METHODS: Qualitative content analysis of SNAP-Ed annual plans from all 50 states, District of Columbia, Guam, and the US Virgin Islands between fiscal years 2014 and 2016. RESULTS: Between 2014 and 2016, the percentage of states that included PSEs as a statewide goal increased from 25% to 47%, and the percentage that planned to implement at least 1 PSE increased from 56% to 98%. Among states that planned to implement PSEs in 2016, the 3 most common settings were places in which people learn (92%), live (90%), and work (83%). CONCLUSIONS AND IMPLICATIONS: The increased planned use of PSEs in SNAP-Ed was considerable and encouraging as PSEs are important to use in conjunction with direct education and social marketing to improve nutrition and prevent obesity.

Breastfeeding Duration Is Associated With WIC Site-Level Breastfeeding Support Practices.

OBJECTIVE: To describe Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) site-level breastfeeding support practices and associations with breastfeeding outcomes. DESIGN: Secondary analysis of WIC Infant and Toddler Feeding Practices Study-2, including data from interviews with caregivers of infants and interviews and surveys with staff from 27 WIC state agencies and 80 study sites. PARTICIPANTS: A total of 1,235 mothers of breastfed infants participating in the WIC Infant and Toddler Feeding Practices Study-2. MAIN OUTCOME MEASURE: Any and fully breastfeeding 2, 6, and 12 months postpartum. ANALYSIS: Descriptive statistics described WIC site-level breastfeeding supports. Multilevel mixed modeling of breastfeeding at 2, 6, and 12 months, controlling for site- and participant-level characteristics. RESULTS: Five WIC site-level supports were significantly and independently associated with any and fully breastfeeding: access to breastfeeding peer counselors, access to International Board Certified Lactation Consultants, postnatal home visits, allowing any WIC staff member to provide breast pump education, and having a policy not to provide formula during the first 30 days postpartum. Likelihood of any and fully breastfeeding increased with each additional site-level support present (odds ratio = 1.09, 95% confidence interval, 1.06-1.12; and odds ratio = 1.26, 95% confidence interval, 1.21-1.31, respectively). CONCLUSIONS AND IMPLICATIONS: Positive associations between site-level supports and breastfeeding at 2, 6, and 12 months were observed. Additional research is needed to understand how site-level supports interrelate and whether specific combinations are more effective, and to identify variations in implementation of breastfeeding supports.

Cooking Matters for Adults Improves Food Resource Management Skills and Self-confidence Among Low-Income Participants.

OBJECTIVE: Determine the impact of Cooking Matters for Adults (CM) on food resource management (FRM) skills and self-confidence 6 months after course completion. DESIGN: Quasi-experimental design with nonequivalent comparison group and 6-month follow-up. SETTING: Cooking Matters for Adults programs in CA, CO, ME, MA, MI, and OR. PARTICIPANTS: Participants in CM attending classes in April to July, 2016 (n = 332); comparison group (n = 336). INTERVENTION: Cooking Matters for Adults educated low-income adults to shop for and prepare healthy meals economically using hands-on meal preparation, facilitated discussion, and an interactive grocery store tour. Classes met for 2 hours, once a week for 6 weeks. MAIN OUTCOME MEASURE(S): Food resource management practices; FRM self-confidence (ie, in shopping for and preparing healthy foods on a budget); worrying that food might run out. ANALYSIS: Pearson's chi-square test and t tests identified measures associated with outcomes of interest and between-group differences. Repeated-measures linear mixed models with fixed and random effects were used to examine differences in outcomes between participants in CM and nonequivalent comparison group and to estimate the treatment effect of the program at 3 and 6 months after course completion. RESULTS: Six months after course completion, CM participants demonstrated improvements in all outcome measures of interest: Use of FRM practices improved (P = .002) as did FRM confidence (P < .001). Participants also worried less that food would run out before they had money to buy more (P = .03). CONCLUSIONS AND IMPLICATIONS: This study demonstrated a positive impact of including FRM skills and confidence building in a nutrition education program, the effects of which could be seen for 6 months after participation in the program. Equipping low-income families with FRM skills allowed them to access healthier foods even during times of hardship.

The extent and patterns of multiple chronic conditions in low-income children.

BACKGROUND AND OBJECTIVES: Little is known about the magnitude of multiple chronic conditions (MCC) in children. This study describes the prevalence of and patterns of comorbidities in children receiving Medicaid assistance. METHODS: Diagnoses from 5 years of Medicaid claims data were reviewed and identified 128,044 children with chronic conditions. The relationship between comorbidities and significant urgent health care events was analyzed using logistic regression modeling. RESULTS: More than 15,000 children (12%) had claims for more than 1 condition. The most frequent combination was asthma and allergic rhinitis. Significant health care events ranged from 18% to 51% in children, and the odds of having a significant event increased with each additional condition. Those with ≥4 conditions had 4.5 times the odds of a significant event compared with those with 1 condition (P < .0001). CONCLUSION: MCC are prevalent in low-income children and are associated with greater risk for urgent health care use.

Asthma coalition effects on vulnerable sub groups of children: the most frequent users of health care and the youngest.

OBJECTIVE: To examine the impact of Allies Against Asthma, community-based coalitions working to improve asthma outcomes, on vulnerable children: those with the most urgent health care use and those of youngest age. METHODS: Allies zip codes were matched with comparison communities on demographic factors. Five years of Medicaid data (n = 26,836) for significant health care events: hospitalizations, ED and urgent care facility visits, were analyzed. Longitudinal analyses using generalized estimating equations and proportional hazards models compared Allies and comparison group children. RESULTS: In the two start-up years of Allies, odds of having a significant event were greater for Allies children than for comparison children (p < 0.05). During the third and fourth years when Allies activities were fully implemented, for frequent health care users at baseline, odds of an asthma event were the same for both Allies and comparison children, yet in the less frequent users, odds of an event were lower in Allies children (p < 0.0001). In the initial year of Allies efforts, among the youngest, the Allies children had greater odds than comparison children of an event (p < 0.01), but by the fourth year the Allies group had lower odds (p = 0.02) of an event. Hazard ratios over all years of the study for the youngest Allies children and most frequent baseline users of urgent care were lower than for comparison children (p = 0.01 and p = 0.0004). CONCLUSION: Mobilizing a coalition of diverse stakeholders focused on policy and system change generated community-wide reductions over the long-term in health care use for vulnerable children.

Selected diet and lifestyle factors are associated with estrogen metabolites in a multiracial/ethnic population of women.

Diet and lifestyle factors, body size, and smoking behavior may influence estrogen metabolism, but the nature of these relations may vary according to race/ethnic groups. We evaluated the association of lifestyle factors with estrogen metabolites 2-hydroxyestrone (2-OHE1) and 16alpha-hydroxyestrone (16alpha-OHE1) in a racially diverse population. With a cross-sectional study design, urine samples from 1881 African-American, Caucasian, Chinese, Japanese, and Hispanic women, aged 42-52 y, from the Study of Women's Health Across the Nation (SWAN) were assayed by EIA for 2-OHE1 and 16alpha-OHE1. Dietary factors and beverages were measured using a modified Block FFQ. Dietary fiber, vegetable and fruit servings, Brassica vegetables, polyphenols, coffee, caffeine, green and black tea, and total alcohol and wine were related to metabolite values using multiple variable regression analyses. In adjusted analyses, 2-OHE1 concentrations were significantly associated with race/ethnicity, weight, smoking, and consumption of hydroxybenzoic acid, anthocyanidins, wine, and caffeine (P < 0.05). Regression models incorporating these variables explained 19-20% of the variation in 2-OHE1 concentrations. Regression models for 16alpha-OHE1, which explained 16-17% of the variability, included race/ethnicity, smoking, caffeine, total dietary fiber, and fiber from fruits and vegetables as variables. These associations may reflect why increased consumption of polyphenol-containing foods and fruit as well as decreased smoking, caffeine intake, and body size would be consistent with hypothesized benefits and risks for selected health outcomes.

Sarcopenia is related to physical functioning and leg strength in middle-aged women.

BACKGROUND: In the aging process, loss of muscle is relatively continuous, but the initiation, timing, and amount of muscle loss that relate to functional compromise are poorly described. Also poorly understood is whether strength and functioning in aging are related to the amount of lean mass and its change as well as to the amount of fat mass and its change. METHODS: The purpose of the study was to ascertain whether 3-year lean and fat mass change predicted functional status in 712 African American and Caucasian women, aged 34-58 years. Fat and lean mass were assessed with bioelectrical impedance. Lower leg strength (torque) was measured with a portable isometric chair, and two indices of physical functioning, walking velocity and double support (both feet touching the surface while walking), were measured with an instrumented gait mat. RESULTS: Almost 9% of middle-aged women had at least a 6% loss (>2.5 kg) of lean mass over the 3-year observation period. Women who lost at least 2.5 kg of lean mass had slower walking velocity and less leg strength, although women who simultaneously gained more than 2.5 kg of fat mass (at least 7.5%) did not have less leg strength. Age was significantly associated with less velocity, less leg strength, and more time in double support. CONCLUSIONS: Even in middle-aged women, there is loss of lean mass among almost 1 woman in 10, and this loss of lean mass (sarcopenia) is associated with greater compromise in physical functioning.